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Although the common method for evaluating OB is body mass index (BMI), it is not specific enough when it comes to reflecting visceral fat. The perirenal fat thickness (PFT) might present better predictive capabilities. The goal of this research was to assess the clinical usefulness of PFT in the diagnosis of KSD and to clarify the molecular mechanisms connecting OB to KSD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Analysis was carried out on a retrospective cohort of 413 patients (265 having KSD and 148 controls). Abdominal computed tomography was used to measure PFT. Three machine-learning methods, weighted gene co-expression network analysis, and differential expression analysis were used to evaluate gene expression data for key gene identification. Internal and external datasets were used to develop and validate a diagnostic nomogram. Also, pathway enrichment analysis was carried out.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>KSD patients exhibited greater PFT versus controls, with significantly enhanced diagnostic accuracy compared to BMI. Multivariate analysis confirmed PFT as an independent predictor of KSD (OR\u2009=\u20091.20, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Eight genes that are differentially expressed in relation to OB were identified, among which FAM20A and DHRS9 were found to be central hub genes. The nomogram exhibited a high level of predictive accuracy. Analysis of enrichment pointed to the IL-6\/JAK\/STAT3 and TNF-\u03b1\/NF-\u03baB signaling pathways in the connection between perirenal fat and KSD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>PFT serves as a practical and dependable marker for the risk of KSD. It is superior to BMI and can be conveniently incorporated into routine clinical practice. Stone formation may be linked to perirenal fat by FAM20A and DHRS9 via inflammatory pathways, which provides potential targets for the management of OB-related KSD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12944-025-02686-4","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T01:32:39Z","timestamp":1756431159000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A cross-sectional and bioinformatics-based analysis: perirenal fat thickness as a superior predictor of kidney stone disease"],"prefix":"10.1186","volume":"24","author":[{"given":"Kaifeng","family":"Mao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fenwang","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenquan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bingfeng","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genggeng","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sucai","family":"Liao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaping","family":"Xing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenyan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruidong","family":"Ji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yige","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenda","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junsheng","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"2686_CR1","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1053\/j.ajkd.2023.03.017","volume":"82","author":"S Shastri","year":"2023","unstructured":"Shastri S, Patel J, Sambandam KK, Lederer ED. 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